Neurodevelopmental and Behavioral Pediatrics

Spina Bifida - General Overview

Description

Spina bifida, a neural tube defect, is also known as myelomeningocele or meningocele.  Neural tube defects are a group of birth defects of the brain, spine, or spinal cord.  Other neural tube defects include lipomeningocele, spina bifida occulta, occult spinal dysraphism. 

Spina Bifida occurs when the spinal cord fails to close completely during fetal development. Because the spinal cord does not close completely the nerves of the spinal canal are damaged.  This can result in a variety of health and developmental issues. 

Causes of Spina Bifida

The exact causes of neural tube defects are not known.  Getting enough folic acid, a type of B vitamin, before and during pregnancy can help to prevent neural tube defects.  Mothers who are obese, have poorly controlled diabetes, and mothers who take certain antiseizure medicines are at more risk of having a baby with a neural tube defect.

Diagnosis

Spina bifida is usually detected before birth by ultrasound.  The open area of the spinal cord is surgically closed shortly after birth by a neurosurgeon.  

How Many People Have Spina bifida

Spina bifida affects 1, 500 babies every year, which is about 3.5 of every 10, 000 births

Associated Developmental and Learning Issues

  • Movement/mobility difficulties: Children with spina bifida can have varying abilities to move.  Some can walk independently or with a walker.  Others use a wheelchair or require more assistance. 
  • Communication difficulties: Some children with spina bifida develop speech skills later than other children their age and may have difficulty with pragmatic language skills.
  • Learning:  Children with spina bifida have a range of intellectual abilities.  Some learn as quickly and well as other children their age.  Some have mild delays.  Others need significant support for learning throughout their life. 

Associated Medical Conditions

Many children with spina bifida have other health complications.  It is important that these are recognized and treated.  A child with spina bifida who is physically healthy is more likely to do well in school and in other treatments.  This contributes to more independence, better daily functioning, and better quality of life.  Common health issues for children with spina bifida include:

  • Bladder control problems
  • Kidney problems, including infections and hydronephrosis and kidney stones
  • Bowel control problems
  • Hydrocephalus (extra fluid and pressure on the brain), and other neurologic issues
  • Spine issues including spinal cord tethering
  • Bone and muscle problems such as scoliosis, muscle shortening (contractures), club foot, hip dysplasia/dislocation, osteoporosis
  • Seizures and other neurologic issues
  • Gastrointestinal issues including constipation
  • Skin breakdown
  • Growth and nutrition problems, obesity

Spina bifida itself does not get worse over time.  However, how it affects a person may be different at different points in the person’s life.  Symptoms like bowel and bladder control and muscle and bone problems can bet better, worse, or stay the same during the course of a person’s life.  Although spina bifida is not "curable" in the usual sense, treatment can help improve function and prevent complications.

Associated Behavioral Conditions

  • Attention Deficit Hyperactivity Disorder
  • Executive Function Difficulties

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